Provider Demographics
NPI:1114904117
Name:CHAU, KIM M (DMD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:M
Last Name:CHAU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 BOSTON POST RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-2463
Mailing Address - Country:US
Mailing Address - Phone:978-440-8177
Mailing Address - Fax:978-440-8175
Practice Address - Street 1:111 BOSTON POST RD
Practice Address - Street 2:SUITE 104
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-2463
Practice Address - Country:US
Practice Address - Phone:978-440-8177
Practice Address - Fax:978-440-8175
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA18835122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist